A Pharmacist-Led Antiplatelet Therapy Stewardship Initiative in Patients With Atrial Fibrillation Receiving Concomitant Oral Anticoagulants and Single Antiplatelet Therapy

Concomitant therapy with anticoagulants and antiplatelets in patients with atrial fibrillation and chronic coronary syndrome significantly increases the risk of bleeding with no added reduction in cardiovascular disease risk over anticoagulation alone. The primary objective was to evaluate an evidence-based antiplatelet stewardship service designed to deprescribe single antiplatelet therapy in patients with atrial fibrillation receiving oral anticoagulants and a single antiplatelet therapy for both primary and secondary prevention of cardiovascular disease. This retrospective study included adult patients aged older than 18 years with atrial fibrillation who were seen at a tertiary academic heart failure center and received therapeutic oral anticoagulants and single antiplatelet therapy for any cardiovascular secondary or primary prevention. The primary outcome was the acceptance of the antiplatelet deprescribing intervention by both providers and patients. The secondary outcomes included provider- or patient-accepted antiplatelet deprescribing intervention. A total of 71 patients were included in the final cohort of this study. The most common indication for the antiplatelet therapy was chronic coronary disease at 69.0 % followed by primary prevention at 14.1% and stroke at 11.3%. The most common antiplatelet therapy was aspirin 81 mg once daily (83.1%), followed by clopidogrel 75 mg once daily(16.9%). Among the 71 patients, 54 (76.1%) were on non-guideline directed antiplatelet therapy. Of the 54 recommendations, 50 (92.6%) were accepted by the providers, and 43 of the 50 provider-accepted recommendations (86.0%) were accepted by the patients. Conclusion: A pharmacist-led antiplatelet deprescribing service is feasible in a tertiary heart failure cardiology outpatient setting. Most recommendations were accepted by the providers and patients.